Our Last (and Best!) Birth Plan

I have these grand plans to write down all of the birth stories (or at least finish El Gato’s), but I am only sort of together with that.  While reading click clack gorilla recently, it struck me that I never shared our birth plan, which seems a shame since we put so much time and energy into writing it, and only 3 or 4 people ever saw it at all!  Not that it is a huge literary masterpiece or anything, but someone might find it useful.

A Birth Plan, by Mr. K and Ms. E

Before Labor Begins:

• As long as the baby and Ms. E are healthy, we would like to go at least 10 to 14 days over the baby’s due date (9/11/11) before inducing labor.
• As long as the baby and Ms. E are healthy, we would like to have no time restrictions on the length of our pregnancy.
• We will be laboring at home as long as possible.
• We trust that our practitioner or any other health care providers will seek out our opinion concerning all of the issues directly affecting our birth before deviating from our plan.

Vaginal exams:

• Please obtain permission before stripping Ms. E’s membranes during a vaginal exam.  This needs to be discussed with us first.
• We prefer to have no vaginal exams until Ms. E goes into labor.
• During a vaginal exam, we prefer at no time to have the amniotic sac broken unless there is an emergency situation.
• We would like to have limited internal vaginal exams during labor.  Please ask first.

Induction:

• If induction becomes necessary, we would like to try natural induction techniques first:
  • Breast stimulation
  • Walking
  • Herbs
  • Enema
  • Castor oil
  • Chiropractic
  • Acupuncture
  • Sexual intercourse

• If medical induction becomes necessary, we prefer to try stripping/rupturing membranes first.
• If Ms. E’s water breaks spontaneously before she goes into labor, we would like to wait 24 or more hours before any induction techniques are introduced.  We understand the need to maintain a sterile vaginal environment and are prepared to take the needed measures to prevent infection (heating toilet paper, no baths, no sex, etc).

Environment:

• Upon arrival at the hospital, we prefer to have our family together at all times.  We expect that there will be both of us, our 5 children, a caregiver for the younger children, and various friends and support individuals.  Our children are as follows: Hershaw, who is 15, Muse, who is 11, Dream, who is 9, Bean, who is 7, and O, who is 5 years of age.
• Please, no residents or students attending the birth unless they take notes unobtrusively, as observers.  We reserve the right to show them the door if they become a problem.

Miscellaneous environment items:

• Dimmed lights.
• Music will be playing, probably continuously.
• Ms. E will be catching the baby herself, in whatever position feels comfortable.  Please respect this and do not suggest other positions.
• If loud talking and unneeded chatter could be conducted outside the room, this would be helpful.
• Ms. E will be wearing her own clothes during labor and delivery.
• There will probably be photography/video/etc.  Ms. E might even be working or at least checking in with work while in labor.
• Please keep the door closed and remind others to close it.

Pain Relief:

• Ms. E wishes to be offered NO external means of pain relief.  She is perfectly comfortable laboring on her own.  This is not negotiable.

Other Considerations:

• Ultimately, Ms. E wants to be able to walk around and move as she wishes while in labor.  She will probably wander out into the rotunda and walk in circles at some point.  Please respect her autonomy.
• Ms. E would like to feel unrestricted in accessing any sounds of chanting, grunting, or moaning during labor.  Judging by previous labors, she will probably be pretty quiet and solitary for much of the labor process, but every birth is different.
• It is preferred that health care providers bother Ms. E as little as possible.  She has no problem being on her own in a corner, laboring away….it is preferred.  Please trust that she will seek out the help she needs.

Monitoring:

• In general, Ms. E would not like to be monitored, but she will tolerate being intermittently monitored to allow for as much mobility and the least amount of bother as possible.  Please respect this and keep monitoring to an absolute minimum.
• PLEASE USE A LARGER SIZE BLOOD PRESSURE CUFF TO GET AN ACCURATE READING.  During prenatal visits, it was discovered that the larger cuff is preferred.

Second Stage Labor:

• Please keep in mind that Ms. E wants to catch the baby herself.  She has already delivered some of her children unassisted, and would like to do so again.
• As long as the baby and Ms. E are healthy, we prefer to have no time limits on pushing.
• Please do not tell Ms. E when to push, how to push, or to stop pushing.  She will follow her instincts on this.
• She may or may not try the following different positions for labor:
  • Squatting
  • Classic semi-recline
  • Hands and knees
  • On the toilet
  • Standing upright
  • Side Lying

Episiotomy:

• Ms. E prefers to have NO episiotomy and risk tearing.  If needed, she will apply warm compresses, oil, or use perineal massage.  She might ask for help with this.

The Delivery:

• Ms. E would like to catch the baby, guide him as he emerges, and pull him onto her abdomen after he is born.
• We prefer to have the lights dimmed for delivery or, if it is daylight, to access only natural light.
• It’s important to Ms. E to push instinctively.  She does not want to be told how or when to push.
• We would like the shoulders and body of the baby to be born spontaneously, on their own.

After Baby is Born:

• As long as our baby is healthy, Ms. E will place him immediately in skin-to-skin contact on her abdomen.   A warm blanket to put over him at this time would be appreciated.
• Please do not separate her and the baby until after he has successfully breastfed on both breasts.
• Please delay all essential routine procedures on our baby until after the bonding and breastfeeding period.  We will not be bathing our child at this time, but would prefer to rub the vernix into his skin.

Cesarean:

• If a C-Section is not an emergency, please give us time alone to think about it before asking for our written consent.
• Mr. K is to be present at all times during the c-section.  Our two oldest children are welcome to be present as well, but the three youngest should join their caregiver outside of the room.
• Ideally, Ms. E would like to remain conscious during the procedure.
• Ms. E would like the baby to be shown to her immediately after he is born.
• Ms. E would like to have contact with the baby as soon as it is possible in the delivery room.
• Ms. E prefers to have a hand free to touch the baby.
• We would like to photograph or film the operation as the baby comes out.
• We would like to film or photograph only the baby after delivery.
• If possible, please discuss anesthesia options with us (including morphine options).
• Ms. E prefers a low transverse incision on her abdomen and uterus.
• Please respect our wishes to be quiet during the operation (e.g., avoiding “small talk” with other practitioners in the room).
• Recovery (check all that apply)
  • If our baby is healthy, Ms. E would like to hold him and nurse him immediately in recovery.
  • We would like to sign any waivers necessary to permit us to be with our baby in recovery.
  • As long as our baby is healthy, Ms. E would like Mr. K to be the baby’s constant source of attention until she is free to bond with him (i.e., holding, skin-to-skin contact, etc.).
  • Please pay special attention to our nursing needs in recovery.  Ms. E may need some “extra help” nursing after the operation.
  • Ms. E would like to have her catheter and IV removed ASAP after our recovery period.
  • Please discuss what Ms. E can expect to feel immediately following the procedure.

Third Stage Labor:

• Please wait for the umbilical cord to stop pulsating before it is clamped and cut.  We will be holding a lottery amongst our kids, friends, and family as to who gets to cut the cord (probably from names in a jar)
• We would prefer for the placenta to be born spontaneously, without the use of chemical/hormonal augmentation, and/or controlled traction on the umbilical cord.
• We would like to take home the placenta.

Newborn Procedures:

• If the baby has any problems, we would like Mr. K to be present with the baby at all times, if possible.
• We would like to have routine newborn procedures delayed until bonding and breastfeeding have occurred.
• We would like all newborn routine procedures to be performed in our presence.

• Administration of Eye drops
  • Please do not administer prophylactic eye drops to our baby, as there is no identified need to do so.  We will use colostrum in the place of antibiotics if there is a problem with this.
  • Vitamin K
    • Please do not administer vitamin K to our baby.
    • Immunizations
      • We will not be immunizing our infant at this time.  There is a waiver with our FB paperwork and also with our pediatrician’s office.
      • Bathing, Clothing, and Diapering Baby
        • Please do not bathe our baby or use lotions on him.  We have our own.
        • We will be bringing our own cloth diapers/cloth wipes and using them.  Please save any plastic diaper samples for another family.
        • Our baby has his own clothing and blankets that we will be using.
        • Circumcision:
          • Please do not offer to circumcise him.
          • PKU/Metabolic Disorders Testing:
            • We would like to wait and delay the PKU testing until we are ready to leave the hospital.  We are willing to make arrangements to return to the hospital to have this done if we are discharged early.
            • Feedings:
              • Our baby is to be exclusively breastfed.
              • We are not interested in formula samples; please save these for another family.
              • Do not offer our baby the following without our consent:
                • Formula
                • Pacifiers
                • Any artificial nipples
                • Sugar water

In Case of Problems/Emergencies:

• If our baby’s health is in jeopardy, we would like to be transported with our baby if possible.  If Ms. E cannot be moved, Mr. K is to go with the baby.
• Ms. E would like to breastfeed or express our milk for our baby.
• We would like to have as much bodily contact with our baby as possible.

Other hospital preferences:

• We would like our in-hospital routine to be full rooming in, no separation, no exceptions, unless our baby is sick.
• We prefer to have Mr. K stay with Ms. E  for the duration of our hospital stay.  If he needs to attend to our other children, one of our friends or family members might take on this role temporarily.
• We would like our other children (regardless of age) and guests to be allowed to visit for as long as they wish or as long as hospital policy permits.

Thanks again for taking the time to read our birth plan.  We realize that some of our approaches may be uncommon, and we hope that you will work with us to have the birth we want while navigating the minefield of hospital policies.

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